We're always happy to answer questions you may have about eye care and treatments. Here's a selection of questions and answers that we've already helped our patients with.
LASIK can benefit a great number of people with myopia, hyperopia and astigmatism. Candidates should have a strong desire to be less dependent on corrective lenses, have established realistic expectations, and understand the risks associated with the surgery.
LASIK is the acronym for laser in situ keratomileusis, sometimes referred to as laser assisted in situ keratomileusis. The name refers the use of a laser to reshape the cornea without invading the adjacent cell layers. In situ is Greek for "in the natural or normal place." Medically, in situ means confined to the site of origin without invasion of neighboring tissues. Kerato is the Greek word for cornea and mileusis means "to shape."
LASIK has been performed internationally for approximately 10 years. It was first performed in clinical trials in the U.S. in 1995. It is important to note that the major components of the procedure have a long history. Ophthalmologists have been reshaping the cornea for over 50 years, creating a protective layer of tissue for over 35 years, and using the excimer laser since the 1980s.
LASIK can benefit a great number of people with myopia, hyperopia and astigmatism. Candidates should have a strong desire to be less dependent on corrective lenses, have established realistic expectations, and understand the risks associated with the surgery.
There are a number of factors that doctors must evaluate before they can determine who is an eligible candidate for LASIK. Some doctors deem certain pre-existing conditions contraindications to the procedure and will not perform surgery if you possess them. Sometimes, factors exist that preclude a patient from being an ideal candidate for LASIK surgery. In many cases, a surgeon may still be able to safely perform the procedure, given that the patient and physician have adequately discussed the risks and benefits and set realistic expectations for results.
LASIK is only one type of refractive surgery available to patients. Although you may not be eligible for LASIK, you may be eligible for a different procedure. You would need to discuss your options with your ophthalmologist.
Most surgeons agree that if you are comfortable wearing contact lenses and are not bothered by being dependent on them, you should carefully evaluate the risks and benefits of LASIK.
LASIK improves the uncorrected vision - one's vision without wearing corrective lenses - in most patients who have the procedure. Over 90% of patients with low to moderate myopia will achieve 20/40 vision, which is considered the minimum allowed by most states and provinces to drive without having to wear contacts or glasses. Over half of all patients can expect to achieve 20/20 vision or better. However, there are no guarantees that you will have perfect vision, and patients with high myopia (more than -7D) and high hyperopia (more than +4D) should have a different set of expectations. People who are most satisfied with the results of laser correction possess realistic expectations of what their vision will be like after surgery.
Patients need to understand that 20/20 vision after LASIK might be different from 20/20 with corrective lenses. Some people describe the images they see post-operatively as not being as "crisp" as those seen through glasses.
Fast visual recovery characterizes this operation. Most patients achieve good vision the day of surgery and find that their eyes feel fairly normal within a day. However, vision can continue to improve, and best vision can still take two to three months to occur. If necessary, adjustments to the surgery called enhancements can be done. Patients who undergo hyperopic LASIK often need to wait longer to able to see clearly. Typically, they are unable to see with intense clarity for one or two weeks, with best vision coming in several months post-operatively.
The most common symptom is blurred vision. As the cataract develops, the progressive clouding can make night driving difficult by intensifying the reflection of lights. Symptoms differ from one person to the next. It depends on the type of cataract and how far it has progressed.
Diet, medicine, eye drops or exercise have not been shown to retard or prevent the development of cataract. A cataract does not result from using the eyes too much or by reading in bad light.
Ideally with modern methods, cataract can be removed at any stage, but it should be operated when it interferes with your daily life.
With the modern technique of Phaco, the cataract needs to be broken inside the eye. As the cataract advances it hardens making it difficult to remove by Phaco. Over-matured cataract can burst in the eye and result in complete loss of vision. Thus Phaco surgery needs to be done while the cataract is still soft.
Phacoemulsification is a good technique with advantage of micro incision, no stitches, safer and faster recovery.
Foldable lenses are good as they can be inserted through micro incision requiring only a small puncture. With advance optics foldable lenses the quality of vision especially at night and low light conditions is much better.
Use drops as directed. Wear protective sunglasses whenever you are outside on sunny days if the glare causes discomfort. Avoid direct pressure on the eye ? don't rub or scratch the eye.
It depends on the eye and the healing responses of the body. Gross work can be done without glasses but fine work may require a visual aid.
Daily routine work can be resumed after a rest of 2 days depending on the work environment. Dust, pollution and stressful conditions should be avoided.
The disease affects the part of the retina called the macula, which is responsible for central vision. Vision loss from AMD typically occurs gradually and can affect both eyes at different rates. Even though macular degeneration can cause visual impairment, the disease usually does not cause peripheral (side) vision loss or lead to total blindness.
"Dry" form: The most common form of macular degeneration is caused by aging and thinning of the tissues of the macula. It develops slowly and usually causes mild vision loss. As this form of the disease develops, people often notice a dimming of vision while reading.
"Wet" form: Rare, and more severe. The wet form of the disease causes new blood vessels to grow beneath the retina, which leak fluid and blood, often creating a large blind spot in the center of the visual field. It may progress rapidly causing significant central vision loss.
The causes of macular degeneration are not completely understood. Some scientists believe heredity may play a part, as well as UV light exposure, nutrition, and cigarette smoking. Studies are ongoing.
"Dry" form - There is no proven effective treatment for dry macular degneraation. Low vision rehabilitation can help those with significant vision loss to maintain excellent quality of life. High dose antioxidant vitamin therapy may help prevent some patients with dry macular degeneration from developing the wet form of the disease. "Wet" form - a variety of therapies are available for we macular degeneration; including intravitreal injection, photodynamic therapy, and rarely laser photocoagulation.
The cells in persons with diabetes mellitus have difficulty using and storing sugar properly. When blood sugar gets too high, it can damage the blood vessels in the eyes. This damage may lead to diabetic retinopathy.
Background or non proliferative diabetic retinopathy - blood vessels in the retina are damaged and can leak fluid or bleed. This causes the retina to swell and form deposits called exudates.
Many patients may not notice any change in their vision when they develop this early form of the disease, but it can lead to other more serious forms of retinopathy that severely affect vision. Fluid collecting in the macula is called macular edema and may cause difficulty with reading and other close work.
Proliferative diabetic retinopathy - New, fragile blood vessels grow on the surface of the retina. These new blood vessels are called neovascularization, and can lead to serious vision problems, because the new vessels can break and bleed into the vitreous. When the vitreous becomes clouded with blood, light is prevented from passing through the eye to the retina. This can blur or distort vision and frequently causes sudden and severe loss of vision. The new blood vessels can also cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and can lead to blindness if untreated. In addition, abnormal blood vessels can grow on the iris (the colored part in the front of the eye), which can lead to severe glaucoma.
Good control of diabetes with intensive management and control of blood sugar will delay, and possibly prevent, both the development and progression of diabetic retinopathy.
Patients with diabetic retinopathy frequently need to have special photographs of the retina taken. This series of photos is called fluorescein angiography.
Laser photocoagulation is one of the most common treatments for diabetic retinopathy. Focal photocoagulation consists of laser directed at the retina to seal leaking blood vessels in patients with background diabetic retinopathy. Panretinal photocoagulation consists of laser spots scattered through the sides of the retina to reduce abnormal blood vessel growth (neovascularization) and help seal the retina to the back of the eye in patients with proliferative diabetic retinopathy. This can help prevent retinal detachment. There is little recuperation needed after laser surgery for diabetic retinopathy. Laser surgery may require more than one treatment to be effective.
Vitrectomy surgery is performed for patients with very advanced proliferative diabetic retinopathy or retinal detachment. In vitrectomy, the surgeon removes the blood-filled vitreous and replaces it with a clear solution. This allows light to pass through the clear fluid to the retina, where the images are conveyed to the brain. Pharmacotherapy: Increasingly, a variety of medications are being used to treat the manifestations of background and proliferative diabetic retinopathy. These involve intravitreal injections of small amounts of medication into the eye.
The type of retinopathy, as well as the patient's general health and eye structure will determine the kind of treatment needed and the type of anesthesia utilized.
Some people may occasionally see small specks or clouds moving in your field of vision. These are called floaters. Floaters are actually tiny clumps of gel or cells inside the vitreous , the clear jelly-like fluid that fills the inside of the eye. While these objects look like they are in front of the eye, they are actually floating inside. When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. Posterior vitreous detachment is more common in people who:
When the vitreous shrinks, it tugs on the retina, creating a sensation of flashing lights. The flashes of light can appear off and on for several weeks or months. As we grow older, it is more common to experience flashes.
As the shrinking vitreous gel pulls away from the wall of the eye, it can cause a retinal tear in places where the vitreous gel sticks too tightly to the retina. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters. A torn retina is always a serious problem, since it can lead to a retinal detachment.
As the vitreous gel in the back of the eye starts to liquefy, it can separate from the retina, a condition called vitreous detachment. If the vitreous gel adheres too firmly to the retina, a retinal tear can occur with a vitreous detachment. A retinal detachment occurs when fluid leaks through the tear and separates the retina from the back of the eye.
Patients with a retinal tear or detachment often, but not always, have flashes and floaters as their first symptoms. This occurs as the vitreous gel detaches from the back of the eye. Other patients may have very few symptoms. Patients may describe a "curtain" being drawn across the peripheral vision or decreased peripheral vision. If untreated, most retinal detachments will cause progressive loss of vision and eventually total blindness.
In most instances, retinal tears are treated with laser photocoagulation which acts to "spot weld" the retina to the back of the eye. In some cases pneumatic retinopexy is used to treat retinal detachment in the office without the need of surgery. In most cases, however, surgery is usually required. This consists of scleral buckling , vitrectomy , or a combination of the two procedures. These are usually performed as outpatient surgeries and may involve using a gas bubble to help push the retina back into position.
Laser is a highly focused and concentrated beam of light that is usually performed to decrease leakage in the retina, treat abnormal blood vessel growth, or create a beneficial scarring effect that can help prevent a retinal detachment. Laser treatment is performed in our office, with no hospitalization, and generally requires no special postoperative restrictions.
Special eye drops are used to numb the eye (topical anesthesia) to reduce any discomfort during the procedure. Sometimes, an injection of local anesthesia to numb the entire area around the eye is needed.
Intravitreal Injections are increasingly important for patients with retinal diseases. Many of these treatments are directed at inhibiting Vascular Endothelial Growth Factor (VEGF). Vascular Endothelial Growth Factor (VEGF) is a substance made by cells that stimulates the growth and leakage of abnormal new blood vessels. VEGF plays a large role in the development of wet age-related macular degeneration (AMD) and other retinal vascular diseases. Multiple new treatments for wet age related macular degeneration that block VEGF are now clinically available. These treatments are given as a series of injections into the eye (intravitreal injection). Intravitreal injections are performed in the office, using an anesthetic to minimize patient discomfort and antiseptic to minimize the risk of infection. Patients are able to continue with all normal activities after an injection. In many cases, repeated injections are necessary to achieve the desired effect.
Was the first of these agents to become available, gaining FDA approval in December of 2004. Macugen binds and inactivates a VEGF subtype (VEGF-165) thought to be most important in disease progression.
Is an anti-VEGF treatment that is FDA approved for intravenous use in metastatic colon cancer. Due to its similarity to other anti-VEGF agents used in macular degeneration and its widespread availability, Avastin has become commonly used by retina specialists in small doses as an intravitreal injection. Avastin is used in an off-label (non-FDA approved) fashion for treating wet age related macular degeneration, diabetic retinopathy, and retinal vein occlusions. Although mounting evidence has demonstrated the effectiveness and safety of Avastin, further trials are underway to investigate the use of Avastin inside the eye.
Is the newest and most effective anti-VEGF agent approved by the FDA for the treatment of wet age-related macular degeneration (AMD). In 2 clinical trials, a majority of patients receiving monthly injections of ranibizumab maintained their vision. Moreover, approximately one-third of ranibizumab patients had improvements in vision at 12 months. Lucentis is the first treatment for wet macular degeneration to show an average improvement in visual acuity after one year of treatment in clinical studies
A sophisticated microsurgical technique in which the vitreous gel is removed from inside the eye with a small, specialized cutting device, an operating microscope to look into the eye, and microsurgical instruments. The vitreous gel is then replaced with a clear saline fluid. Vitrectomy is performed for many conditions including retinal detachment, diabetic retinopathy, macular pucker or hole, hemorrhage or infection inside the eye, and ocular trauma. Vitrectomy is usually performed under local anesthesia.
A special plastic material is placed around the outside to help close off (or "buckle") retinal tears in patients with a retinal detachment. We also have specialized equipment that enables us to repair certain retinal detachments in the office without the need for hospitalization or scleral buckling.
Fundus Fluorescein angiography is a clinical test to look at blood circulation in the retina at the back of the eye. It is used to diagnose retinal conditions caused by diabetes, age-related macular degeneration, and other retina abnormalities. The test can also help follow the course of a disease and monitor its treatment. It may be repeated on multiple occasions with no harm to the eye or body.(insert FFA PHOTOGRAPH)
Normal OCT: Quick, safe and informative-this new Eye scanner is a glimpse into the future of patient care… It gives live cross sections magnified slices of various structures of the eye, giving a better insight in the treatment of the eye disease.
Retinal OCT: Optical Coherence Tomography, “OCT” for short is a non-invasive technology used for imaging the retina , the multi-layered sensory tissue lining the back of the eye, is revolutionizing the early detection and treatment of eye conditions such as macular holes , pre-retinal membranes , macular swelling and even optic nerve damage.
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